Important Submission Information
HEALTHCARE CLAIMS
New Claims must be submitted with a fully completed and signed Reimbursement Claim Form.
NEED A HEALTHCARE FORM
If you have received a Substantiation Letter or Denial Letter, please submit your receipt(s) and/or documentation with the letter you received from EBPA.
DEPENDENT CARE CLAIMS
The IRS guidelines are very specific for the submission of Dependent Care Claims. NEED A DEPENDENT CARE FORM
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Please note: The uploaded file must be DOC, DOCX, PDF, GIF, JPG, PNG, TIFF or TIF in format. The uploaded file must be less than 28MB in size.
Please note: Renaming a non-supported file tyle to a suported file types will not be accepted. EXAMPLE: myreceipt.png to myreceipt.pdf
Browsers supported: IE, Mozilla Firefox, Google Chrome, Safari, Edge
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